<h4>Employment (Optional)</h4>
<hr>

<div class="form-group">
  <label class="control-label col-md-2">Employer name</label>
  <div class="col-md-10">
    <input class="form-control"></input>
  </div>
</div>

<div class="form-group">
  <label class="control-label col-md-2"></label>
  <div class="col-md-10">
    <input class="form-control"></input>
  </div>
</div>

<div class="col-md-offset-2">
  <label><input type="radio">Previously employed</label>
  <label><input type="radio">Currently employed</label>
</div>

<div class="form-group">
  <label class="control-label col-md-2">State/Province</label>
  <div class="col-md-10">
    <select class="form-control">
      <option>Month</option>
    </select>
    <input class="form-control"></input>
  </div>
</div>
